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[Durata di psicosi non trattata e deterioramento cognitivo in una coorte di pazienti psicotici cronici.]

Dipartimento di Sanità Pubblica, Medicina Clinica e Molecolare dell'Università di Cagliari, Sezione di Psichiatria. Clinica Psichiatrica, Dipartimento Salute Mentale ASL Cagliari, Italia.
La Clinica terapeutica (Impact Factor: 0.33). 164(4):e263-e271.
Source: PubMed

ABSTRACT Scopi. L'esito dei disturbi psicotici, soprattutto se afferenti allo spettro schizofrenico, sembra essere correlato, tra i diversi fattori in gioco, anche alla latenza del trattamento del primo episodio di psicosi (durata della psicosi non trattata, DUP) che appare tanto peggiore quanto più ampio è il divario di tempo intercorso tra l'insorgenza dei primi sintomi psicotici e il primo trattamento farmacologico. Pochi studi hanno però focalizzato la loro attenzione sul ruolo della durata di psicosi non trattata in rapporto all'esito in termini di funzionamento cognitivo, che rappresenta una rilevante componente fenomenica delle sindromi psicotiche, sia non affettive che non affettive, e un parametro di esito con forti correlazioni con lo sviluppo di disabilità. Il nostro studio si è proposto di analizzare eventuali correlazioni tra durata di psicosi non trattata al primo episodio e il deterioramento cognitivo nel lungo termine in un campione di psicotici cronici. Materiali e Metodi. Il nostro campione è costituito da 82 pazienti cronici ambulatoriali, 49 di sesso maschile (59,8%) e 33 di sesso femminile (40,2%), di età compresa tra i 20 e i 74 anni (età media 46,59 anni, D.S. 10,68), affetti da schizofrenia (n=41, 50%), disturbo bipolare tipo I con caratteristiche psicotiche congrue o incongrue con l'umore (n=18, 22%) e disturbo schizoaffettivo (n=23, 28%) sec. DSMIVTR, nei quali la diagnosi era stata confermata mediante l'intervista strutturata SCID-I. A ciascun paziente è stata somministrata la Wechsler Adult Intelligence Scale Revised (WAIS-R) per studiare il profilo cognitivo. Risultati. Una lunga durata di psicosi non trattata,intesa come una durata superiore a tre mesi tra esordio dei primi sintomi psicotici e l'inizio del primo trattamento farmacologico, è associata ad una ridotta performance in 9 delle 11 sottoscale della WAIS, nei punteggi ponderati totali e nei punteggi di QI verbale, di Performance e Totale. La presenza di una associazione fra una DUP più lunga e maggiori indici di deterioramento cognitivo è stata confermata, limitatamente ad alcuni subtest, nel campione dei pazienti schizofrenici e schizoaffettivi. Conclusioni. Questo studio apporta ulteriori evidenze a favore di un'associazione tra lunga durata della psicosi non trattata e maggiori livelli di deterioramento cognitivo anche nel lungo termine.

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